First hospitals in B.C. colon cancer screening program swamped with referrals

Rollout delayed in rest of province after facing challenges in Victoria

‘We’ve talked to the other health authorities. So now when we roll it out elsewhere, we do know some of the challenges that will need to be overcome,’ said Health Minister Terry Lake.

Photograph by: Ward Perrin
, PNG

The much-ballyhooed provincial colon cancer screening program has hit some hitches that will delay its start-up.

The government first announced the program last spring. The Vancouver Island Health Authority volunteered to be the first region to implement it a few months ago. But two hospitals in Victoria have been swamped with referrals for colonoscopies. Demand has so outstripped the available supply of hospital space, doctors and nurses that the government has told other health authorities to do a better job anticipating demand before rolling out similar programs.

“From what I understand, VIHA put up their hands and said ‘we want to be the first to do this,’” said Health Minister Terry Lake in a recent interview. “And as it turned out, there were renovations going on in some operating rooms that decreased the availability of some rooms, and also they had challenges with having (enough) nurses trained to assist in the procedures.

“So they did it, and then they bumped up against these challenges. But again, they are working through that. They’re training more nurses. They’re looking at the availability of ORs,” he said.

While the provincial program was supposed to have been implemented throughout the province by this summer, it is now expected to roll out across the Lower Mainland, the North and the Interior in late September.

Lake said other health authorities are learning from the experiences on Vancouver Island.

“We’ve talked to the other health authorities. So now when we roll it out elsewhere, we do know some of the challenges that will need to be overcome. We may not have the same challenges in other health authorities. Maybe there’s more OR availability in Kelowna and Kamloops so that isn’t a problem. But we want to make sure that they’re all ready to go before it rolls out elsewhere.”

Dr. Max Coppes, CEO of the BC Cancer Agency, said Monday that the government is giving the agency $2 million a year to coordinate and manage the program, maintain a registry, and set quality assurance standards. The experience on Vancouver Island, where referrals to gastroenterologists have tripled, has come as a surprise.

Coppes said the fact that family doctors and their patients are using the stool kits and then being referred to specialists when abnormal results indicate colonoscopies or other follow-ups are warranted is a good thing.

The goal of the program is to find more cancers in the earliest stage, when they are up to 90 per cent curable. There are about 3,000 new colorectal cancer cases in B.C. each year. In both incidence and mortality among cancers, it ranks second for men and third for women.

On the island, the government has given VIHA about $200,000, over and above the $600,000 already budgeted for colonoscopies, to clear the backlog.

A colonoscope is a flexible instrument with a camera at the tip. The instrument is inserted into the bowel, through the anus, to look for, and remove, pre-cancerous and cancerous polyps and tumours.

The program utilizes nurse navigators, also called patient coordinators, who contact patients when stool sample results are positive. They also help schedule appointments with specialists. Coppes said the goal is to get colonoscopies completed within 60 days of a positive fecal test that indicates a growth is shedding blood.

“We’ll have a registry and will be able to monitor any part of the province that doesn’t meet that benchmark,” Coppes said.

The colon screening program is targeted to the 50- to 74-year-old age group since the vast majority of all such cancers occur in that age group. Historically, the government has paid about $35 million a year for tests and procedures related to colon cancer screening. Coppes said it’s estimated that costs will rise about $10 million a year under the new organized program, but the level of public participation will dictate whether the amount is more or less.

About 230,000 B.C. residents provided a stool sample last year. But there are nearly 1.5 million people in the targeted age group and they will be sent regular reminders to get tested every few years through the new program.

Lake said the screening program represents good value:

“If we can head off colorectal cancer in a patient, we’ve saved a tremendous amount of money.”

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